Strategies to support self-regulated learning in integrated, student-centered curricula

Figures & data

Table 1. Explanation of how first-year medical students engage the FORETHOUGHT PHASE of SRL in an integrated, learner-centered curricula.

Tasks	Behaviors	Examples
Forethought Phase: Goal Setting
Managing time	Creating a plan for when to accomplish goals	‘Before I think I used to spend maybe an hour or two doing prework and then do “PEARLS*,” but now I feel it all ties into “PEARLS.’ Maybe I do prework reading for PEARLS, or maybe I do other sources for PEARLS, but in my mind it all goes into PEARLS now. So I only do structure and PEARLS prework, but in the process of doing that I think I cover the majority of the lecture material as well.’ *PEARLS = Patient-centered Explorations in Active Reasoning, Learning & Synthesis, a hybrid problem/case-based learning curriculum.
	Creating schedules to complete tasks	‘I usually use Google calendar and then look at the things that are listed on Just in Time Medicine and see what we have to do and look at the resources, estimate how much time I think that’s going to take me and then block that off on the calendar.’
Managing content	Consolidating new information with old knowledge	‘So usually on the first day, [like] Saturday or Friday I usually try to consolidate the week beforehand just so that – because everything comes together in the following week as well.’
	Integrating multiple learning objectives	‘Now I look at all the learning objectives. I don’t really read them in detail but I put them onto Google or PowerPoint slides, like one learning objective per slide.’
Forethought Phase: Strategic Planning
Task organization	Identify the scope of a task or the boundaries of the learning.	‘So I found that I try to actually answer the learning objectives and I might read the first few sections of the pre-reading just to get myself sort of situated and like understanding okay, where are we and kind of to see that perspective.’
	Breaking a task/ learning of knowledge into its component parts.	‘But I'll go day by day, like Lga* and PCG* on Monday. So I'll look at all of that stuff and I just read through it, the objective and I say, okay, let me get like a picture, like a little snapshot of what we’re trying to learn right now. Like what’s, what’s the theme more or less of this day? Then I kind of look for the big core objectives.’ *LGA = Large Group Activity is a weekly session that integrates basic science and clinical knowledge and is taught to all first year students using a combination of lecture, case-based work and peer learning. *PCG = Post-Clinic Group is a twice weekly session where eight students and a clinician engage in case-based learning.
Previewing new content	Extracting organizational frameworks from pre-readings in order to build conceptual understanding	‘We have the key concepts within the weekend learning module. So I use those to just take notes and it gives a really good background of the whole week.’
	Learning new vocabulary to begin development of foundational knowledge.	‘It was like learning a completely new language and so I think that’s why CPR [Challenges, Privileges, and Responsibilities; first course of School 2’s curriculum] was so stressful because it’s like I didn’t have the language…But now I kind of have a general framework of where things are in the body. I'm a lot more comfortable with the new language that I've learned.’
	Watching videos or looking at pictures/ charts to increase foundational understanding before engaging in learning across content areas.	‘I'll pick out videos from the different resources that I use and I put [them in a] long kind of a to do list and then as the week goes on I'll stagger them with what I think is important to know.’
Tasks generated from self-reflection	Plan to target learning gaps.	‘I try to find videos from step one prep materials and stuff to prep for the week. And it’s a good supplement after doing the key concepts because I already have a good framework in my mind. So the outside videos just kind of solidify everything.’
	Generate questions for office hours	‘So I make up some questions and try to go to office hours kind of prepared.’

Table 3. Explanation of how first-year medical students engage the SELF-REFLECTION PHASE of SRL in an integrated, learner-centered curricula.

Tasks	Behaviors	Examples
Self-reflection Phase: Self-evaluation
Self-evaluation and analysis	Use question banks, flash cards, or learning objectives to quiz themselves and make changes to study habits as needed	‘At the end of the week if I'm going through flashcards and I keep getting like the same flashcards wrong that coincide with a specific boards and beyond video or a whole two to three pages of first aid then I'll like stop doing cards, reread those pages or rewatch that video to cement it in and then try to do the cards again.’
Self-reflection Phase: Course-evaluation
Course-evaluation analysis	Use grades and summative/formative evaluation at the end of each course to reflect on performance and make changes to study habits as needed	‘If I feel unsure about the weekly essay, I already know I have to consolidate, but it’ll also be easier for me to consolidate once I see what they wanted me to know in that weekly essay. And I go back to the suggested LOs [learning objectives] from the week from the PEARLS case, and be like okay, did I do my research well enough that I could answer these questions on my own?’
Self-reflection Phase: Co-reflection
Utilize peer preparation as a benchmark for learning	Go to class and see if you can keep up with everyone	‘If I get stuck when we go over it again during review & reinforcement or – then the next session they talk about something that happened the day before or a couple of days before, and I’m still a little lost, that’s when I start realizing that I haven’t known it as well as I thought I do.’
Utilize peers to support self-reflection	Explain material to another student, go to office hours with other students	‘And because I now study in groups, I hear – because I’m an audio learner I hear a lot of bounce back, and I’m like oh, I didn’t have that fact, and now that fact is in my head forever. So it’s just like oh, what’s this piece of information you learned versus I didn’t hear this in my group but you heard it in your group, so it goes back and forth, and that’s how I assess before exam time.’

Figure 1. Representation of the broad findings within each phase of SRL. 

Table 2. Explanation of how first-year medical students engage the PERFORMANCE PHASE of SRL in an integrated, learner-centered curricula.

Tasks	Behaviors	Examples
Performance Phase: Rehearsal
Rehearsal to support memorization and recall	Multiple passes through notes and course materials to learn the information, reciting, memorizing or naming items from a list of key words and concepts	‘So the way I kind of think about it is I like to take multiple passes at material and the first pre-reading is like an introduction and I'm just kind of getting a sense of the raw basics and terminology. The second pass is in the large group or structure and then I like to get some time, like a couple weeks between when I go back to it and see what I remember.’
Performance Phase: Elaborating
Connecting new knowledge to previous learning	Trying to relate the material to what learners already know, generative note taking.	‘So even if it’s like a biochemical concept, which is difficult to actually get a look at it, I will try to draw a diagram and draw a picture because a block of text does not make as much sense to me as just looking at a picture.’
Articulating main ideas	Attempting to summarize or paraphrase material	‘Most of the time I do my research in textbooks and I try to put them into my own words and rephrase them in a way I feel it’s like an appropriate amount of detail for the course.’
Performance Phase: Organizing
Synthesizing ideas	Clustering, use of videos to generate framework for learning	‘I think a good way I did it was watch videos in the beginning as an introduction, because videos – there’s no way they can go as in-depth as a textbook about all the different proteins and what’s not involved. So videos are a good foundation – a main resource – and then you build on top of that by going into textbooks.’
Developing foundational understanding within a specific subject/ topic	Selecting the main ideas in reading passages, outlining	‘So I read the text and I take notes and I generally organize. There’s usually learning objectives that come with the classes and so depending on learning objectives I'll look at them. And if I like them I use them to structure my notes especially if they morph well with the reading.’
Performance Phase: Self-testing
Self-testing for the purpose of developing recall	Using flashcards or other learning resources to self-test in order to solidify learning of current content	‘So right after I watched the video, I do note cards and retain everything that I just read or I just watched.’